1. 1 Diagnosis

2. 2 Most important information: “History, history, history!” Eye witness account and persons own account of event (s) Eye witness account and persons own account of event (s) Medical history Medical history Family history Family history

3. 3 A diagnosis of epilepsy is not usually made after a one off or two seizures It is hard to remove the label of epilepsy so it is important to be cautious when making the diagnosis There are other causes of seizures…..

4. 4 Differential diagnosis Febrile convulsions Febrile convulsions Faints Faints Cardiovascular events Cardiovascular events Migraine Migraine Metabolic disorders Metabolic disorders Disassociative seizures or non epileptic event disorder Disassociative seizures or non epileptic event disorder Some people may have both epilepsy and non epileptic seizures

5. 5 None of these conditions will respond to anti-epileptic medication. In the UK, up to 30% of people referred to specialist epilepsy centres do not have epilepsy which is why their seizures have remained uncontrolled

6. 6 Key questions to ask What happened prior to the event What happened prior to the event What exactly happened during the event What exactly happened during the event How was the person directly after the event How was the person directly after the event

7. 7 Tests to assist with diagnosis These are not diagnostic tests Blood tests & ECG to help rule out other causes for the events Blood tests & ECG to help rule out other causes for the events EEG (be aware that people with migraine can have abnormal EEGs and that in most cases, unless the person has a seizure during the test the results will be normal) EEG (be aware that people with migraine can have abnormal EEGs and that in most cases, unless the person has a seizure during the test the results will be normal) CT scan CT scan MRI scan MRI scan Brain scans will not show anything if there is no structural cause, or if the abnormality is very small

8. 8 Err on the side of caution… If there is doubt about the cause of the events, let time assist you. Ask the person and their family to make close observations of any other events and to come back.